Del Fabbro Massimo, Taschieri Silvio, Corbella Stefano
Department of Biomedical, Surgical and Dental Sciences, UniversitÀ Degli Studi Di Milano, Milan, Italy.
Fondazione IRCCS CA' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Clin Implant Dent Relat Res. 2025 Jun;27(3):e70053. doi: 10.1111/cid.70053.
Maxillary sinus floor augmentation (MSFA) with lateral approach has undergone considerable changes since its inception, mainly due to the introduction of a variety of grafting materials and surgical protocols, with the aim of providing predictable and durable support to implants and improving treatment outcomes. The aim of this systematic review was to evaluate the performance of MSFA in terms of graft stability and implant survival, based on randomized clinical trials.
The study protocol was registered on PROSPERO. An electronic search was performed on Medline, Embase, and CENTRAL databases, integrated with hand-searching on the main pertinent Journals and search of gray literature. Randomized studies on MSFA with a lateral approach reporting on radiographic changes in graft height or volume after at least six months of healing, implant survival, and marginal bone level changes after at least 12 months of loading were included. Two independent reviewers selected the studies. Studies included underwent data extraction and risk of bias assessment using the ROB 2.0 Cochrane tool.
Out of 3922 studies retrieved, 49 studies (57 articles) were included for data extraction and qualitative analysis. These studies reported on 1265 patients and 1722 MSFA procedures. Thirteen studies were at low risk, 30 had some concerns, and six were at high risk of bias. No quantitative synthesis was possible due to the characteristics of the studies and their methodology. The overall implant survival rate ranged from 84.6% to 100% without evidence of any relevant difference related to the grafting material.
The results of this review, based on descriptive statistics, may suggest that the success of the lateral MSFA procedure is independent of the graft type, at least in the short term. To verify this interpretation, formal statistical analyses on trustworthy and more detailed clinical data are needed. Also, long-term data on graft dimensional stability from evidence-based studies are needed.
自上颌窦底外提升术（MSFA）开展以来，其手术方式发生了显著变化，这主要归因于多种植骨材料和手术方案的引入，旨在为种植体提供可预测且持久的支持，并改善治疗效果。本系统评价的目的是基于随机临床试验，评估上颌窦底外提升术在植骨稳定性和种植体存留方面的表现。
研究方案已在国际前瞻性系统评价注册库（PROSPERO）登记。对Medline、Embase和CENTRAL数据库进行了电子检索，并结合对主要相关期刊的手工检索以及灰色文献的搜索。纳入采用外提升术式的上颌窦底外提升术随机研究，这些研究报告了至少6个月愈合后的植骨高度或体积的影像学变化、种植体存留情况以及至少12个月负载后的边缘骨水平变化。由两名独立评审员筛选研究。纳入的研究使用ROB 2.0 Cochrane工具进行数据提取和偏倚风险评估。
在检索到的3922项研究中，49项研究（57篇文章）被纳入数据提取和定性分析。这些研究报道了1265例患者和1722例上颌窦底外提升术。13项研究偏倚风险低，30项存在一些问题，6项偏倚风险高。由于研究及其方法的特点，无法进行定量综合分析。总体种植体存留率在84.6%至100%之间，未发现与植骨材料相关的任何显著差异。
基于描述性统计的本评价结果可能表明，至少在短期内，外侧上颌窦底外提升术的成功与植骨类型无关。为验证这一解释，需要对可靠且更详细的临床数据进行正式统计分析。此外，还需要基于循证研究的植骨尺寸稳定性的长期数据。
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